VRA Certificate Required IN THE DISTRICT/SUPERIOR COURT FOR THE STATE OF ALASKA AT ANCHORAGE STATE OF ALASKA MUNICIPALITY OF ANCHORAGE Plaintiff, ) ) ) ) ) ) ) ) vs. CASE NO. 3ANFOR REQUEST AND ORDER ST: Comm. Lic. CR DOB: APSIN: ATN: Defendant. DL/ID: DEFENDANT'S REQUEST (type or print neatly) CERTIFICATION. I certify that this document and its attachments do not contain (1) the name of a victim of a sexual offense listed in AS 12.61.140 or (2) a residence or business address or telephone number of a victim of or witness to any crime unless it is an address used to identify the place of the crime or it is an address or telephone number in a transcript of a court proceeding and disclosure of the information was ordered by the court. I, Reason: , request that Date Defendant's Mailing Address Daytime Phone Defendant's Signature Email Address PROSECUTOR'S REPLY ( Prosecutor does does not oppose this request. Reason: not necessary) Date Hearing ordered. Date: Request granted. Request denied. COURT'S ORDER Time: Prosecutor's Signature Courtroom: ABA# Date Judge Type or Print Judge's Name I certify that on DMV AASAP CWS a copy of this order was given or sent to: DA/MA DVIP MOA/SOA Collections TCA Jail Deft DPS DOC by Clerk: Jail CR-770 ANCH (4/17)(cs) REQUEST AND ORDER American LegalNet, Inc. www.FormsWorkFlow.com Crim. R. 44(f) & Adm. Bull. 53 AS 12.61.110, AS 12.61.130

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